Chinese Journal of Plastic and Reconstructive Surgery最新文献

Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest. Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clinical course. By researching the evolution of the disease in this study, we aimed to summarize our experience of managing a rare patient who underwent five surgeries for keloidal dermatofibroma that developed sequentially in the upper arm and chest and propose a novel treatment for keloidal dermatofibroma. We concluded that keloidal dermatofibroma involving larger areas, high tension sites, and multiple localizations can be treated using the principles of pathological scar management.

Mucormycosis, a rapidly invasive form of fungal infection caused by Mucorales fungi, has high morbidity and mortality rates. Rhino-orbital-cerebral mucormycosis is the most common form of mucormycosis. With the coronavirus disease 2019 (COVID-19) outbreak, a causal correlation between mucormycosis and COVID-19 has been suspected, contributing to the abrupt increase in opportunistic fungal infection cases. We present a case of a Southeast Asian woman in her 60s with complaints of pus discharge in the palatal region with maxillary teeth mobility for 3 months. Physical examination revealed multiple nonvital upper teeth with severe mobility. Incisional biopsy of the maxilla and multidetector computed tomography of the head and neck confirmed the diagnosis of osteomyelitis of the maxilla secondary to mucormycosis. Surgical treatment was performed, and amphotericin B and posaconazole were administered. No operative complications or further bone destruction were observed at 8 months postoperatively.

Background

Although the surgical outcomes of free flap reconstruction have improved over time, vascular compromise remains a devastating complication. Near-infrared spectroscopy (NIRS) is a promising new free flap monitoring technique with the potential for better outcomes than clinical monitoring (CM). This systematic review aims to provide a comprehensive review of the current evidence regarding the use of NIRS for free flap monitoring.

Methods

A systematic literature review was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on existing NRIS studies, including the clinical outcomes of NIRS monitoring, speed of detection, diagnostic accuracy, variables affecting NIRS accuracy, and cost-effectiveness.

Results

A total of 24 articles were included in this analysis. In most instances of flap compromise, NIRS enabled earlier detection of compromise than did CM, by an average of 8.1 (0.5–32.0) h. The flap salvage rate of flaps monitored with CM and NIRS (87.2%) was significantly higher than that of flaps monitored with CM alone (50.0%) (P<0.01). The overall survival rate for flaps monitored with CM and NIRS (98.1%) was also significantly higher than that for flaps monitored with CM alone (96.3%) (P=0.02). Blood oxygen saturation was the only variable with a significant effect on NIRS results.

Conclusion

NIRS is an objective and reliable flap monitoring technique that provides superior flap salvage and survival rates compared with CM, which translates to cost savings and a reduction in workload for healthcare staff. Further large-scale studies are needed to standardize flap compromise criterion values and efficacy for different flap types.

Background

The treatment of port-wine stains (PWS) becomes extremely difficult due to age-related malformation of the vasculature. In this study, we used alternative methods to treat hypertrophic PWS.

Methods

A short-pulsed CO₂ laser was applied to ablate the hypertrophic vasculature of PWS. The ablation was ended when the wound was on the same plane as normal skin. The long-pulsed neodymium-doped yttrium-aluminum-garnet (lpNd:YAG) laser was primarily applied to coagulate and subsequently liquefy the hypertrophic vasculature of the PWS. The therapeutic energy used in treating different lesions should be carefully regulated to significantly affect the treatment outcomes.

Results

The two cases presented herein demonstrated substantial improvement in hypertrophic vasculature that was largely removed. The skin was resurfaced, although some scar formation and mild hypopigmentation occurred.

Conclusion

We suggest the use of short-pulsed CO₂ and lpNd:YAG lasers for treating certain cases of hypertrophic PWS. When using a short-pulsed CO₂ laser, it is wise to judge the treatment endpoint and take appropriate precautions to avoid intraoperative bleeding. When using an lpNd:YAG laser, the therapeutic energy should be controlled according to the thickness of the lesion to reduce scar formation.

Skeletal muscle regeneration mainly depends on muscle satellite cells; however, these cells are not sufficient for supporting repair and regeneration in volumetric muscle loss (VML), Duchenne muscular dystrophy, and other muscle injuries or muscle diseases. As such, much work has been conducted in recent years to search for myogenic stem cells. Adipose-derived stem cells (ADSCs) have a wide range of sources, rapid growth, and multi-directional differentiation potential, and have become vital candidates for muscle regeneration. Multiple factors influence the myogenic differentiation capacity of ADSCs. This paper reviews the regulatory aspects and possible factors that have been identified in recent years to affect myogenic differentiation of ADSCs. Based on these factors, gene editing, and perfusion concepts, a method was proposed to achieve maximal differentiation efficiency of ADSCs. This study focused on the application of ADSCs in muscle regeneration and disease. Based on the importance of myogenic differentiation of ADSCs for the repair and regeneration of muscle damage, this study provides a basis for future research surrounding the efficient induction of myogenic differentiation of ADSCs in vitro.

With improvements in living standards and advancements in medical technology, the demand for fat reduction and body shaping is increasing. Non-invasive fat reduction and body shaping therapy has gradually become a research hotspot in plastic surgery. High-intensity electromagnetic technology, a non-invasive treatment that can reduce subcutaneous fat and strengthen muscle, has been increasingly applied in clinics in recent years. This article reviews the fat reduction and body shaping mechanism and clinical effects of this equipment and provides a reference for its clinical application.

Background

Traditional full-incision double eyelid blepharoplasty has several significant disadvantages, including slow recovery and bilateral asymmetry, which results in high rates of patient dissatisfaction. These problems can be minimized using improved surgical techniques aimed at reducing tissue damage and bleeding, decreasing operation time, and especially at protecting the subcutaneous capillary network during the operation. We therefore aimed to guard the capillary network and reduce intraoperative bleeding using the practical technique of reverse orbicularis oculi muscle resection.

Methods

Fifty cases of double eyelid blepharoplasty with traditional full-incision (group A) and 61 cases of reverse double eyelid blepharoplasty with a preserved capillary network (group B) were divided into two groups from October 1 to December 31, 2021 and from March 1 to May 31, 2022, respectively. The orbicularis oculi muscle was removed reversely from the front of the tarsal plate using double eyelid blepharoplasty, and the muscular membrane and subcutaneous capillary network were preserved. The operation time recorded in previous medical records was checked and compared with that of our novel technique. The recovery of double eyelid blepharoplasty was determined at 1, 4, and 12 weeks after the operation and patient satisfaction was also compared with that in previous medical records of patients in group A.

Results

The reverse double eyelid blepharoplasty procedure was less complicated and easier to control than the traditional full-incision double eyelid blepharoplasty methodology. The average operation time of the double eyelid blepharoplasty cases with traditional full-incision was significantly greater than that of the cases of reverse double eyelid blepharoplasty with the capillary network preserved (45.68 ​± ​5.27 ​min and 31.11 ​± ​5.58 ​min, respectively; t=14.018 9, P=0.000 0). Patient satisfaction was 42% and 78.69%, respectively, at 1 week post-operation (χ²=15.724 8, P=0.000 1), 62% and 90.16% at 4 weeks post-operation (χ²=12.490 2, P=0.000 4), and 90% and 95.08%, at 12 weeks post-operation (χ²=1.061 1, P=0.303 0).

Conclusion

Reverse double eyelid blepharoplasty with preserved subcutaneous capillary network effectively decreases the operation time and improves post-operative patient satisfaction. It is a double eyelid blepharoplasty method worthy of popularization.

Background

Management of severe velopharyngeal dysfunction is best performed by a multispecialty team. This team could include a speech-language pathologist, otolaryngologist, prosthodontist, and a plastic surgeon. The most commonly performed surgical procedures in complicated cases with scarred soft palate are sphincter pharyngoplasty and pharyngeal flaps. In this study, a multidisciplinary approach was applied for proper assessment and surgical intervention using sphincter pharyngoplasty for velopharyngeal insufficiency after cleft palate repair.

Methods

Twenty patients underwent sphincter pharyngoplasty. Preoperative diagnosis was performed using auditory perceptual assessment, nasoendoscopy assessment, nasometry, and videofluoroscopy.

Results

There were statistically significant differences between the preoperative and postoperative assessments. Bleeding occurred in two patients. Obstructive sleep apnea occurred in three patients and was resolved spontaneously within three months, and one patient experienced slight wound dehiscence.

Conclusion

Velopharyngeal dysfunction after cleft palate repair is best treated by a multidisciplinary team through speech therapy together with sphincter pharyngoplasty.